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Identification of high-risk factors and construction of a risk stratification prediction model for postpartum hemorrhage in women with scarred uterus

Huanlin Ma(1),


(1) Department of Obstetrics, Fuyang Campus of Zhejiang Provincial People’s Hospital, China (The First People's Hospital of Fuyang District),Hangzhou City 310000,Zhejiang Province,China
Corresponding Author

Abstract


This retrospective single-center study aimed to identify high-risk factors for postpartum hemorrhage (PPH) in women with scarred uterus and to construct a risk stratification prediction model. Clinical data from 271 women with scarred uterus who delivered between January 2019 and January 2025 were collected. PPH was defined as blood loss >500 mL after vaginal delivery or >1000 mL after cesarean section. The above women were randomly classified into train set (n=189) and test set (n=82) at a 7:3 ratio.. Univariate analysis was applied to screen the potential risk factors, and multivariate logistic regression analysis was performed to identify independent predictors of PPH and establish a prediction model. The results showed that production times≥2, placenta accreta, and hemoglobin level were independent risk factors for PPH. A prediction model was constructed based on these variables. Receiver operating characteristic (ROC) analysis demonstrated a good discriminatory ability, with area under the curve (AUC) values exceeding 0.7 in both the train and test sets. Hosmer-Lemeshow test indicated a good model calibration degree, and decision curve analysis suggested favorable clinical utility. This model may provide a practical tool for early identification and risk stratification of PPH in women with scarred uterus.

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